Provider Demographics
NPI:1689763120
Name:ROBBINS, MARK IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:IRA
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4500 BROOKTREE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9289
Mailing Address - Country:US
Mailing Address - Phone:724-933-6569
Mailing Address - Fax:724-933-6536
Practice Address - Street 1:4500 BROOKTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9289
Practice Address - Country:US
Practice Address - Phone:724-933-6569
Practice Address - Fax:724-933-6536
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA550122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR0303040OtherDEA
BR0303040OtherDEA
MA30002099Medicare ID - Type Unspecified